The Bridge Between Medicine and Dentistry (UK)

GDP’s are required to make an on the spot decision about a medical condition and consider how it influences the patient’s dental plan. Frequently this will be around drugs administered and drug complications. It could be as simple as making sure they are familiar with the latest thoughts around proposed treatments. A great deal of medicine is now protocol-driven. These protocols are frequently updated. All GDP’s are required to be fully informed of these numerous and irregular adjustments.  If dentists are found to be out of date they risk of being sued or pursued by the GDC.

Lacking knowledge of the latest thinking is no defence.

The authors of The Bridge believe there is a need for a publication that curates expert advice from a wide variety of sources that will save the GDP time-and keep them right up to date.

The authors ranked the guidance included by credibility and authority of the source. The authors checked multiple, difficult to access, sources saving the busy practitioner, and their team, time and effort. This expert knowledge is now available in a single manual that will be updated annually.

Why the UK practicing GDP needs The Bridge Between Medicine and Dentistry?

• Does your TCO take down the medical history of your patient? Would it be helpful if they had a quick reference text that they could consult to flag up to you potential medical/ drugs issues before you see the patient?
• There is sometimes conflicting advice on how to manage certain conditions? Find guidance on what your patient’s hospital doctor follows. e.g. use of prophylactic antibiotics in patients with joint replacement.
• Are you aware that treatments have changed but you don’t have the time to read up on every new development e.g. new anticoagulants?
• Are you an experienced GDP who has done things your own way for years but you want to be up to date with new protocols that if not followed could leave you vulnerable to be sued? e.g. controlled drug prescription/ MRONJ
• Have you just discovered that your patient is on a drug that you have never heard of? You aren’t sure of the dental implications and what you can prescribe safely? e.g. flecanide
• Are you aware of a colleague who has been taken to task by the GDC where they were criticised for not being up to date or didn’t follow the correct protocol?
• If you perform a google search in front of your patient both you and your patient may wonder if the site you check has enough authority.
• Do you find it a nuisance to search for drug interactions within the BNF when it isn’t specifically giving guidance for a GDP?
• Are you in your first few years of practice and still find yourself coming up against patients who have medical conditions or take medication that you haven’t encountered before? e.g.diabetic patient on Insulin

Contents of The Bridge.

• Clearly laid out by disease or condition on wipe-clean pages with easy-to-search tabs for the busy GDP or TCO to rapidly find the section they are looking for.
• Spiral-bound manual to sit flat whilst allowing pages to be turned with one hand
• A list of the 50 most commonly prescribed drugs by dentists with dosage, UK brand names and drug information specific to the dental practitioner including relevant interactions.
• A pain control ladder describing situations when different analgesics and anti-inflammatory should be prescribed. The latest controlled drugs requirements, which change frequently. There is specific guidance on prescribing opioids if required. 
• A quick reference sheet on commonly prescribed local anaesthetics, including newer drugs and guidance on the use of vasoconstrictors in cardiac patients.
• There are details of drugs that interact with local anaesthetics, including less frequently prescribed medications that patients are on.
• A high proportion of dental patients are already on prescribed medication. The Bridge lists the top 150 drugs prescribed across the United Kingdom. We include brand names, the condition the drug treats and then, specifically, the dental implications of those drugs. Each drug listed is colour coded to highlight those that have the potential for more serious problems.
• There is guidance from the authoritative authors on; antibiotic prophylaxis in cardiac patients, patients with joint replacements, solid organ transplants and other implanted devices. Advice on antibiotic use with dental implants, odontogenic infection and what to prescribe if the patient has an allergy to a specific antibiotic.
• Specific guidance on the management of hypertension, diabetes, respiratory, liver disease and chronic kidney disease.
• The Bridge covers the dental implications of the drugs used in a wide range of medical conditions and when to seek input from a hospital physician.
• A whole section on the recently changed field of anticoagulants. The Bridge covers the preoperative, intraoperative and postoperative management of patients on these drugs. We list drugs that are safe to use with both the older and newer anticoagulants/ antiplatelet drugs. We list the drugs to avoid.
• The Bridge includes up to date guidance on medication-related osteonecrosis (MRNOJ) of the jaw.  There is advice on the drugs associated with MRNOJ, the risk of those drugs and some guidance on how to manage and define MRONJ.

The  Authors

For the 25 years I’ve been an orthopaedic surgeon, my first concern is to keep my patients as safe as I can. To be up to speed with the whole of medicine as it relates to anaesthesia and surgery is impossible. I'm in a fortunate position. I have longstanding relationships with hospital doctors in a wide range of specialities. I can instantly speak with an anaesthetist or a physician of my choice. Frequently, I do this in the middle of a consultation- because I can. I treat, operate upon and prescribe for the same patients as the GDP. I wanted to share the answers to many of the questions that arise when I treat patients by working with my co-authors to bring The Bridge Between Medicine and Dentistry to the UK.

Jonathan Bell FRCS (Orth)

I have been working as a general dental practitioner for over 20 years. The BNF has always been my go-to guide for patients medications, but increasingly the complexity of medications, plus changes in regimes such as the novel anticoagulants, have meant that I can spend longer looking for different guidelines to check that my clinical understanding is in line with current thinking.

There are many excellent guidelines in the UK and The Bridge brings all the latest thinking together in a format with references. As GDP’s we often work in isolation and do not have easy access to medical colleagues to double-check. The format of The Bridge has been carefully thought out to allow easy reference which will be kept up to date with regular updates. It forms an excellent bridge between medicine and dentistry.

Elaine Halley BDS MFGDP MSc

Reviews

"it is obviously well researched, well written, comprehensive, relevant, and to the point – well done!  I wouldn’t be surprised if every dental practice in the UK wanted one of these." Dr Craig Cook, Sedation Solutions

"I've had it a week and I've already used it twice." Dr Chris Orr